Study Questions:

Among patients referred for radiofrequency ablation of atrial fibrillation (AF), what is the relationship between patient-reported outcome measures and health-related quality-of-life (HRQoL) scores on the one hand, and biomarkers, echocardiographic data, hemodynamics, AF episode frequency/duration, anxiety/depression, and obesity on the other?

Methods:

A total of 192 patients eligible for radiofrequency ablation (RFA) of atrial fibrillation (AF) referred to a University Hospital in Sweden were studied. The ASTA (Arrhythmia-Specific questionnaire in Tachycardia and Arrhythmia) symptom scale was used to assess arrhythmia-related symptoms in the patients. The ASTA HRQoL scale and the short-form 36 (SF-36) physical and mental components summaries (PCS and MCS) were used to express disease-specific and overall HRQoL of the patients, respectively.

Results:

Anxiety, low-grade inflammation, and left atrial dilatation significantly predicted arrhythmia-related symptoms (R2 = 0.313; p < 0.001). Depression was the most important predictor of arrhythmia-specific HRQoL (standardized beta: 0.406), and the produced model explained a significant proportion of the variation in arrhythmia-specific HRQoL (R2 = 0.513; p < 0.001). The most important predictor of PCS was obesity (body mass index >30 kg/m2) (standardized beta: -0.301), whereas the most important predictor of MCS was anxiety (standardized beta: -0.437).

Conclusions:

Anxiety, depression, and low-grade inflammation were the factors that predicted both arrhythmia-related symptoms and HRQoL in patients with AF. Obesity was the most significant predictor of patient general physical status. These factors need to be addressed in patients with AF to improve management of their disease. Intensive risk factor modification can be of great importance.

Perspective:

The underlying causes of variability in symptom perception among AF patients, from completely asymptomatic to debilitated, remain a clinical conundrum. Not infrequently in clinical practice, asymptomatic patients, who are diagnosed with AF during a routine physical, subsequently develop compelling symptoms necessitating therapy. The present study suggests that at least some of the reasons for this may be depression, anxiety, inflammation as measured by high-sensitivity C-reactive protein, and obesity. In order to improve symptoms, physicians should consider not only pharmacological or procedural treatment of AF, but also concomitant physiological and psychological comorbidities.